Project ID NS-MH2024_50


Co Supervisor 1A Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, Department of PsychologyWebsite

Co Supervisor 1B Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, Department of PsychologyWebsite

Additional Supervisor Dr Filippo Varese and Dr Liam Mason

How does trauma-focused therapy for psychosis affect the mind and brain?

There is robust evidence showing that the association between trauma and psychosis may be causal. This finding raises important questions about the mechanisms linking trauma to psychotic symptoms, and has stimulated a number of trials to determine whether trauma-focused psychological interventions can help psychotic patients. Identifying and measuring trauma-related mechanisms in these patients, and determining the extent to which their amelioration is necessary for effective treatment, is necessary to lead to more effective interventions.

This project will utilize data from the STAR trial, in which 305 participants with distressing psychosis and post-traumatic stress disorder (PTSD) symptoms were randomly assigned to therapy or Treatment As Usual for 9 months. STAR provides an ideal opportunity to investigate the psychological and neural mechanisms underlying PTSD and psychosis, and how these mechanisms respond to therapeutic intervention. The project will benefit from data from a sub-set of trial participants who completed a week of smartphone-based Experience Sampling Methodology (ESM) (N=155) and underwent fMRI (N=74) pre- and post-therapy.

The findings from this project will enhance the scientific value of the STAR trial by identifying those psychological and neurocognitive mechanisms that must change for psychological interventions to be effective in patients with psychosis who have a history of significant psychological trauma.
Aims: to determine relationships between PTSD and psychosis symptoms and hypothesized psychological and neural mechanisms, and whether symptom improvement is associated with changes in these mechanisms.

Techniques & Skills: Multilevel modelling analyses (ESM), fMRI analyses. The student will have the choice to focus on either and/or ESM/fMRI data, and will have the opportunity to work alongside world-leading, multisite trial team.

Year one: Training in appropriate analyses, literature review, finalising research questions and planned analyses
Year two: Analyses of study hypotheses, write up papers (2/3)
Year three: Finalise analyses, write up papers (1/2) and thesis

Representative Publications

Peters, E.R., Hardy, A., Dudley, R., Varese, F., Greenwood, K.E., Steel, C., Emsley, R., Keen, N., Bowe, S., Swan, S., Underwood, R., Longden, E., Byford, S., Potts, L., Heslin, M., Grey, N., Turkington, D., Fowler, D., Kuipers, E., & Morrison, A. (2022) Multisite randomised controlled trial of trauma-focused cognitive behaviour therapy for psychosis to reduce post-traumatic stress symptoms in people with co-morbid PTSD and psychosis, compared to treatment as usual: study protocol for the STAR (Study of Trauma And Recovery) trial. Trials, 23:429.

Keen, N., Hunter, E.C.M.,?Peters, E. (2017) Integrated Trauma-Focused Cognitive-Behavioural?Therapy for Psychosis:?a?Case-Series Study using Imaginal Reprocessing Strategies for Post-traumatic Stress and Psychotic Symptoms.? Frontiers in Psychiatry, 8:92.??

Mason L.,?Peters E.., Dima D., Williams S.C., & Kumari V.? (2016) Cognitive?behavioural?therapy?normalises?functional connectivity for social threat in psychosis.? Schizophrenia Bulletin, 42(3): 684-692.?

Hardy, A. (2017). Pathways from trauma to psychotic experiences: A theoretically-informed model of post-traumatic stress in psychosis. Frontiers in Psychology, 8, 697.

Hardy, A., O’Driscoll, C., Steel, C., van der Gaag, M. & van den Berg, D. (2020). A network analysis of post-traumatic stress and psychosis symptoms. Psychological Medicine, 51(14), 2485-2492. doi:10.1017/S0033291720001300

Hardy, A., Emsley, R., Freeman, D., Bebbington, P. E., Garety, P. A., Kuipers, E., Dunn, G., Fowler, D. (2016). Psychological mechanisms mediating effects between trauma and psychotic symptoms: The role of affect regulation, intrusive trauma memory, beliefs and depression. Schizophrenia Bulletin, (suppl 1), s34-s43.